Wk Of Rehabilitation Research Articles

Correlation study between motor rehabilitation level and psychological state in patients with limb movement disorders after stroke

BACKGROUND The psychological state of patients with post stroke limb movement disorders undergoes a series of changes that affect rehabilitation training and recovery of limb motor function. AIM To determine the correlation between motor rehabilitation and the psychological state of patients with limb movement disorders after stroke. METHODS Eighty patients with upper and lower limb dysfunction post stroke were retrospectively enrolled in our study. Based on Hospital Anxiety and Depression Scale (HADS) scores measured before rehabilitation, patients with HADS scores ≥ 8 were divided into the psychological group; otherwise, the patients were included in the normal group. Motor function and daily living abilities were compared between the normal and psychological groups. Correlations between the motor function and psychological status of patients, and between daily living ability and psychological status of patients were analyzed. RESULTS After 1, 2, and 3 wk of rehabilitation, both the Fugl-Meyer assessment and Barthel index scores improved compared to their respective baseline scores (P < 0.05). A greater degree of improvement was observed in the normal group compared to the psychological group (P < 0.05). There was a negative correlation between negative emotions and limb rehabilitation (-0.592 ≤ r ≤ -0.233, P < 0.05), and between negative emotions and daily living ability (-0.395 ≤ r ≤ -0.199, P < 0.05). CONCLUSION There is a strong correlation between motor rehabilitation and the psychological state of patients with post stroke limb movement disorders. The higher the negative emotions, the worse the rehabilitation effect.

Unexpected-Disturbance Program for Rehabilitation of High-Performance Athletes.

The Unexpected-Disturbance Program (UDP) promotes exercises in response to so-called involuntary short- to midlatency disturbances. This study investigated the effectiveness of the UDP in the last 6 wk of rehabilitation. Pre-post study with 2-tailed paired t tests for limited a priori comparisons to examine differences. National Sports Institute of Malaysia. 24 Malaysian national athletes. 7 sessions/wk of 90 min with 3 sessions allocated for 5 or 6 UDP exercises. Significant improvements for men and women were noted. Tests included 20-m sprint, 1-repetition-maximum single-leg press, standing long jump, single-leg sway, and a psychological questionnaire. For men and women, respectively, average strength improvements of 22% (d = 0.96) and 29% (d = 1.05), sprint time of 3% (d = 1.06) and 4% (d = 0.58), and distance jumped of 4% (d = 0.59) and 6% (d = 0.47) were noted. In addition, athletes reported improved perceived confidence in their abilities. All athletes improved in each functional test except for long jump in 2 of the athletes. Mediolateral sway decreased in 18 of the 22 athletes for the injured limb. The prevention training with UDP resulted in improved conditioning and seems to decrease mediolateral sway.

Improvement of Outcomes With Nonconcurrent Strength and Cardiovascular-Endurance Rehabilitation Conditioning After ACI Surgery to the Knee

Autologous chondrocyte implantation (ACI) aims to restore hyaline cartilage. Traditionally, ACI rehabilitation is prescribed in a concurrent (CON) format. However, it is well known from studies in asymptomatic populations that CON training produces an interference effect that can attenuate strength gains. Strength is integral to joint function, so adopting a nonconcurrent (N-CON) approach to ACI rehabilitation might improve outcomes. To assess changes in function and neuromuscular performance during 48 wk of CON and N-CON physical rehabilitation after ACI to the knee. Orthopedic Hospital NHS Foundation Trust. Randomized control, pilot study. 11 patients (9 male, 2 female; age 32.3 ± 6.6 y; body mass 79.3 ±10.4 kg; time from injury to surgery 7.1 ± 4.9 mo [mean ± SD]) randomly allocated to N-CON:CON (2:1). Standardized CON and N-CON physiotherapy that involved separation of strength and cardiovascular-endurance conditioning. Function in the single-leg-hop test, patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], International Knee Documentation Committee subjective questionnaire [IKDC]), and neuromuscular outcomes of peak force (PF), rate of force development (RFD), electromechanical delay (EMD), and sensorimotor performance (force error [FE]) of the knee extensors and flexors of the injured and noninjured legs, measured presurgery and at 6, 12, 24, and 48 wk postsurgery. Factorial ANOVAs with repeated measures of group by leg and by test occasion revealed significantly superior improvements for KOOS, IKDC, PF, EMD, and FE associated with N-CON vs. CON rehabilitation (F(1.5,13.4 GG) = 3.7-4.7, P < .05). These results confirm increased peak effectiveness of N-CON rehabilitation (~4.5-13.3% better than CON over 48 wk of rehabilitation). N-CON and CON showed similar patterns of improvement for single-leg-hop test and RFD. Nonconcurrent strength and cardiovascular-endurance conditioning during 48 wk of rehabilitation after ACI surgery elicited significantly greater improvements to functional and neuromuscular outcomes than did contemporary concurrent rehabilitation.

Effect of growth hormone on aging connective tissue in muscle and tendon: gene expression, morphology, and function following immobilization and rehabilitation

It is unknown whether loss in musculotendinous tissue during inactivity can be counteracted by growth hormone (GH), and whether GH accelerate rehabilitation in aging individuals. Elderly men (65-75 yr; n = 12) had one leg immobilized 2 wk followed by 6 wk of retraining and were randomly assigned to daily injections of recombinant GH (rhGH; n = 6) or placebo (Plc; n = 6). Cross-sectional area (CSA), muscle strength (MVC), and biomechanical properties of m. quadriceps and patellar tendon were determined. Muscle and tendon biopsies were analyzed for gene expressions (mRNA) of collagen (COL1A1/3A1) and insulin-like growth factors (IGF-1Ea/Ec). Fibril morphology was analyzed by transmission electron microscope (TEM). In tendon, CSA and biomechanical properties did not change following immobilization, but an increase in CSA was found after 6 wk of rehabilitation in both groups. The changes were more pronounced when GH was injected. Furthermore, tendon stiffness increased in the GH group. Muscle CSA declined after immobilization in the Plc but not in the GH group. Muscle CSA increased during retraining, with a significantly larger increase in the GH group compared with the Plc group. Both a time and a group effect were seen for IGF-1Ea/Ec and COL1A1/3A1 mRNA expression in muscle, with a difference between GH and Plc. IGF-1Ea/Ec and COL-1A1/3A1 mRNA expression increased in muscle following immobilization and retraining in subjects receiving GH, whereas an increase in IGF-1Ec mRNA expression was seen in the Plc group only after retraining. In conclusion, in elderly humans, GH seems to have a matrix stabilizing effect during inactivity and rehabilitation by stimulating collagen expression in the musculotendinous tissue and increasing tendon CSA and stiffness.

Responsiveness of the Numeric Pain Rating Scale in Patients With Shoulder Pain and the Effect of Surgical Status

The Numeric Pain Rating Scale (NPRS) is commonly used to assess pain. Change in the NPRS across time can be interpreted with responsiveness indices. To determine the minimal clinically important difference (MCID) of the NPRS. Single-group repeated measures. Outpatient rehabilitation clinics. Patients with shoulder pain (N = 136). At the initial evaluation patients completed the Penn Shoulder Score (PSS), which includes pain, satisfaction, and function sections. Pain was measured using an 11-point NPRS for 3 conditions of pain: at rest, with normal daily activities, and with strenuous activities. The NPRS average was calculated by averaging the NPRS scores for 3 conditions of pain. The final PSS was completed after 3-4 wk of rehabilitation. To determine the MCID for the NPRS average, the minimal detectible change of 8.6 points for the PSS function scale (0-60 points) was used as an external criterion anchor to classify patients as meaningfully improved (≥8.6 point change) or not improved (<8.6-point change). The MCID for the NPRS average was also determined for subgroups of surgical and nonsurgical patients. Cohen's effect sizes were calculated as a measure of group responsiveness for the NPRS average. Using a receiver-operating-characteristic analysis, the MCID for the average NPRS for all patients was 2.17, and it was 2.17 for both the surgical and nonsurgical subgroup: area-under-the-curve range .74-.76 (95%CI: .55-.95). The effect size for all patients was 1.84, and it was 1.51 and 1.94 for the surgical and nonsurgical groups, respectively. The NPRS average of 3 pain questions demonstrated responsiveness with an MCID of 2.17 in patients with shoulder pain receiving rehabilitation for 3-4 wk. The effect sizes indicated a large effect. However, responsiveness values are not static. Further research is indicated to assess responsiveness of the NPRS average in different types of patients with shoulder pain.

Comparison of the Somatotropic Axis in Free-ranging and Rehabilitated Harbor Seal Pups (Phoca vitulina)

The somatotropic axis, including growth hormone (GH), insulin-like growth factor (IGF)-I, and IGF binding proteins (IGFBP), is a bridge between growth physiology, developmental age, and nutritional status in domestic animals. However, the importance of the somatotropic axis in nutrition, growth, and development of harbor seals has not been previously explored. Given the difficulty of conducting longitudinal studies in free-ranging harbor seals, this study focused on the potential use of harbor seals in rehabilitation facilities as a model for free-ranging seals. The purpose of this research was to compare concentrations of components of the somatotropic axis in free-ranging versus rehabilitated harbor seal pups. The hypothesis was that measurements of the somatotropic axis will be similar between individuals of comparable age and nutritional status (fasting versus feeding). To investigate this hypothesis, harbor seal pups (n=8) brought to The Marine Mammal Center (Sausalito, California, USA) or Mystic Aquarium (Mystic, Connecticut, U.S.A.) were initially assessed and determined to be healthy but abandoned. All pups were less than 2 wk of age upon arrival at rehabilitation facilities. Standard length was assessed at the time of arrival and again at release. Body mass was measured every week and blood samples were collected from each pup at 0, 4, and 8 wk of rehabilitation. Blood was collected and morphometrics assessed in free-ranging harbor seal pups (n=8) from the Gulf of Maine. Sera were analyzed for GH, IGF-I, and IGFBP concentrations. Concentrations of GH, IGF-I, and IGFBP-2 and -3 in rehabilitated pups were within a similar range compared with free-ranging pups when considered in the context of presumed nutrient intake. These data suggest that rehabilitated harbor seals may provide a useful model to investigate the effects of nutrient intake on growth and development of harbor seals, and will provide insight into phocid endocrinology and metabolism.

Effect of chronic unloading and rehabilitation on human Achilles tendon properties: a velocity-encoded phase-contrast MRI study

The objective of this study was to measure and monitor changes in Achilles tendon mechanical properties and force production capability of triceps surae muscles after 4 wk of limb suspension and 6 wk of physical rehabilitation. Five healthy volunteers underwent unilateral lower limb suspension followed by weekly physiotherapy. A velocity-encoded, phase-contrast magnetic resonance imaging (VE-PC-MRI) technique was used to estimate the tendon strain as a function of force produced during the submaximal isometric contractions. After limb suspension, triceps surae muscle strength decreased to 53.2 +/- 15.6% (mean +/- SD) of the presuspension level (P < 0.05). Young's modulus, estimated from the slope of the tendon stress-strain relationship, decreased by 17.1% (from 140.50 +/- 29.33 to 119.95 +/- 36.07 MPa, P < 0.05), while the tendon transition point, reflecting the "toe region," increased by 55.7% (from 2.2 +/- 1.0% to 3.4 +/- 1.24%). Muscle strength, tendon stiffness, and transition point recovered to presuspension levels by the end of 6 wk of rehabilitation. Calcaneus movement was significant during the "isometric" contraction, accounting for 52.13 +/- 7.63% of the tendon displacement. Tendon cross-sectional area determined from anatomic magnetic resonance axial images remained unchanged, suggesting that the altered tendon elastic modulus and transition point were largely due to material deterioration. The increase in the transition point following chronic unloading as measured by the VE-PC-MRI technique has not been previously reported and offers new insights into the biomechanical changes that may occur in the tendon crimp structure.

Prospective Randomized Trial Comparing Bilateral Lung Volume Reduction Surgery to Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease

Several uncontrolled studies report improvement in lung function, gas exchange, and exercise capacity after bilateral lung volume reduction surgery (LVRS). We recruited 200 patients with severe chronic obstructive pulmonary disease (COPD) for a prospective randomized trial of pulmonary rehabilitation versus bilateral LVRS with stapling resection of 20 to 40% of each lung. Pulmonary function tests, gas exchange, 6-min walk distance, and symptom-limited maximal exercise testing were done in all patients at baseline and after 8 wk of rehabilitation. Patients were then randomized to either 3 additional months of rehabilitation or LVRS. Thirty-seven patients met study criteria and were enrolled into the trial. Eighteen patients were in the medical arm; 15 of 18 patients completed 3 mo of additional pulmonary rehabilitation. Thirty-two patients underwent LVRS (19 in the surgical arm, 13 crossover from the medical arm). After 8 wk of pulmonary rehabilitation, pulmonary function tests remained unchanged compared with baseline data. However, there was a trend toward a higher 6-min walk distance (285 +/- 96 versus 269 +/- 91 m, p = 0.14) and total exercise time on maximal exercise test was significantly longer compared with baseline values (7.4 +/- 2.1 versus 5.8 +/- 1.7 min, p < 0.001). In 15 patients who completed 3 mo of additional rehabilitation, there was a trend to a higher maximal oxygen consumption (V O(2)max) (13.3 +/- 3.0 versus 12.6 +/- 3.3, p < 0.08). In contrast, at 3 mo post-LVRS, FVC (2.79 +/- 0.59 versus 2.36 +/- 0.55 L, p < 0.001) and FEV(1) (0.85 +/- 0.3 versus 0.65 +/- 0.16 L, p < 0.005) increased whereas TLC (6.53 +/- 1.3 versus 7.65 +/- 2.1 L, p < 0.001) and residual volume (RV) (3.7 +/- 1.2 versus 4.9 +/- 1.1 L, p < 0.001) decreased when compared with 8 wk postrehabilitation data. In addition, Pa(CO(2)) decreased significantly 3 mo post-LVRS compared with 8 wk postrehabilitation. Six-minute walk distance (6MWD), total exercise time, and V O(2)max were higher after LVRS but did not reach statistical significance. However, when 13 patients who crossed over from the medical to the surgical arm were included in the analysis, the increases in 6MWD (337 +/- 99 versus 282 +/- 100 m, p < 0.001) and V O(2)max (13.8 +/- 4 versus 12.0 +/- 3 ml/kg/min, p < 0.01) 3 mo post-LVRS were highly significant when compared with postrehabilitation data. The Sickness Impact Profile (SIP), a generalized measure of quality of life (QOL), was significantly improved after 8 wk of rehabilitation and was maintained after 3 mo of additional rehabilitation. A further improvement in QOL was observed 3 mo after LVRS compared with the initial improvement gained after 8 wk of rehabilitation. There were 3 (9.4%) postoperative deaths, and one patient died before surgery (2.7%). We conclude that bilateral LVRS, in addition to pulmonary rehabilitation, improves static lung function, gas exchange, and QOL compared with pulmonary rehabilitation alone. Further studies need to evaluate the risks, benefits, and durability of LVRS over time.

Gait adaptations before and after anterior cruciate ligament reconstruction surgery.

Gait analyses of rehabilitated individuals with anterior cruciate ligament (ACL) deficiency and reconstruction have identified the final adaptations of increased hip extensor torque and hamstring electromyography (EMG) and decreased knee extensor torque and quadriceps EMG during stance. The initial adaptations to injury and surgery are, however, unknown as are the factors that influence the development of the adaptations. Identification of the initial response to injury would provide a basis for determining whether the final adaptations are learned automatically or if they are the result of a lengthy training period in which various factors may affect their development. The purpose of the study was to evaluate the initial effects of ACL injury and reconstruction surgery on joint kinematics, kinetics, and energetics, during walking. Injured limbs from nine subjects with ACL injury were tested 2 wk after injury, and 3 and 5 wk after surgery. Ten healthy subjects were tested. Kinematic and ground reaction data were collected and combined with inverse dynamics to calculate the joint torques and powers. A knee extensor torque throughout most of stance was observed in the injured limbs at all test sessions. This result was in conflict with previous observations of reduced extensor torque or a flexor torque in rehabilitated patients with ACL reconstruction and patients with ACL deficiency. This result also differed from the typical midstance extensor then flexor torque in healthy control subjects. Trend analysis showed a significant (P < 0.001) change in average position at the hip and knee, extensor angular impulse at the hip, and positive work done at the hip 3 wk after surgery followed by a partial rehabilitation at 5 wk after surgery. Power and work produced at the knee were reduced fivefold (P < 0.001) after 5 wk of rehabilitation and did not recover to pre-surgical levels. The existence of a long-lasting knee extensor torque 2 wk after injury indicated that the adaptation process to ACL deficiency is lengthy, requiring many gait cycles, and that numerous factors could be involved in learning the adaptations.

Biochemical evidence of thiamine depletion during the Cuban neuropathy epidemic, 1992–1993

During an epidemic outbreak of neuropathy in Cuba during 1992-1993, blood and urine samples were collected from 107 persons with confirmed neuropathy, from 106 control subjects without clinical abnormality who were broadly matched with the affected persons by age and domicile, and from 537 unmatched subjects, also free from clinical abnormality. The unmatched subjects lived in two locations in Cuba; at each location they were drawn from two age ranges: 11-15-y-old secondary school students and 16-64-y-old adults. Measurements of urinary thiamine and blood transketolase and its activation with thiamine pyrophosphate were made. For the neuropathy subjects, these measurements were repeated after 3 wk of rehabilitation. All groups showed biochemical evidence of thiamine depletion affecting 30-70% of their members, which is a high prevalence. Severity of biochemical depletion was, however, no greater in the neuropathy subjects than in the control subjects (P > 0.05). However, it was greater in Pinar del Rio, where the incidence of disease was higher, than in the city of Havana, where less disease was seen. Although the majority of the affected subjects responded biochemically to a daily oral multivitamin supplement containing thiamine (P < 0.001), in some cases normal biochemical status was not achieved even after 3 wk of intensive treatment. In the affected group, thiamine status was inversely correlated with the amount of alcohol consumed (P = 0.007). Thiamine status at the outset was correlated with clinical outcome after treatment. Although neither thiamine depletion nor alcohol abuse were likely to have been the sole cause of the neuropathy epidemic, they may have been contributory factors. Thiamine supplementation or food fortification may therefore be necessary in Cuba.